Refusing to float

dudette10, MSN, RN · Jul 5, 2016

I wanted to get ya lls opinion on refusing to float. The reason for the floating is because other units aren't properly staffed. Example: full time and prns ask off on the same day and everyone gets it, therefore no one is covering the floor. I work in OB/pediatrics and have never refused a float but currently it has been happening all the time! Our floor is ALWAYS staffed appropriately therefore we feel like sitting ducks when we notice other floors aren't covered. The floors needing to be covered most are medsurg and swingbed. Both of which are completely opposite of OB and pediatrics. What would the consequences be if one refuses to float??

I'm a float nurse, and I've noticed that one floor's staff nurses are always getting pulled to other floors for the same reason you mention: that floor is well-staffed and the others aren't. In my opinion, this isn't a bedside nurse's fight; this is the unit managers' fight. If I was running a well-staffed unit (read: little turnover because my nurses were satisfied with their job), I would be pushing this issue every chance I got in the admin meetings. No way would I allow my staff to become dissatisfied through constant floating because other NMs were not creating a favorable work environment on their floors.

dudette10, MSN, RN · Jul 5, 2016

We get a 3 day unpaid suspension for refusal. That being said, our hospital moved to floating only within that service. Maternal-child only floats NICU-PICU-Nursery-Peds. OB is
closed. Med-surg to med surg, adult ICU-other adult ICU/ER.
We we used to do whole house floats and it was awful. I was sent to burns, cardiac, med surg and surgical ICU. Hello, I work with babies, but the thought was we were ICU nurses, sure but a preemie is not a little
adult! I would tell the charge
nurse that I needed a resource person and made it quite
clear what I could and could not
do. I did feel bad for them
but I had to make sure I kept my license safe.

I have NEVER understood why NURSES in the c-suite and in house manager positions would allow a whole house float policy. Would a neonatologist feel comfortable treating a 90-year old? Would a general surgeon feel comfortable delivering a high-risk baby? So why the hell do they think nurses can do it?

artisticmind · Jul 6, 2016

No way would I allow my staff to become dissatisfied through constant floating because other NMs were not creating a favorable work environment on their floors.

THIS!!! This was our scenario the entire Winter, which at our hospital, still hasn't ended. We were the ONLY fully staffed unit (telemetry) in the hospital. So we had the mandatory privilege of helping lesser staffed units. We went from our normal night ratios of 1:5 and the Charge having 2 to 1:6 with Charge in the count with 3 patients. Day shift went from 1:4 to 1:5 and an open Charge to a Charge with 2-3 or more patients. This started in November.

Now at least once a week we are back up to 1:6 ratios on nights while days is still able to squeak in at their 1:4 ratios. It really sucks seeing day shift complaining about being full with 4 each while we still have to bust our butts at night with 6. This past weekend when filling in as Charge I was told by our staffing/bed board office that we were getting all the admissions because the other tele floor was short staffed for the weekend and they were trying to give them a break. Where was our break while our ratios were pushed up and we worked short since November because we had mandatory floating allowing the other floor to maintain a normal ratio?? Guess what, we are no longer a full staffed unit- we've lost 6 nurses from our night staff that they haven't been able to replace because word has got around how crappy it is.

LadyFree28, BSN, LPN, RN · Jul 6, 2016

Hi nursekc133!
Before you receive report you can review the assignment, the acuity and patient load and refuse the assignment citing the Nurse Practice Act. But your reasons must relate to patient care or your nursing license being jeopardized (I would only use this if you really feel it's necessary). The reasons you stated don't seem to fall under that category. Other than that just call the nursing supervisor and speak with him or her to try and work it out.

YES!!!

Most practice acts have language that specifies if you have NOT been properly educated to take care of a specific patient population, you can not perform said duties for safety as well as violating the nurse practice act.

Now with the abundance of computers, you can always go to one and pull up the language before accepting an assignment. :yes:

quazar · Jul 6, 2016

As a med-surg nurse, in my opinion, it is very difficult to maintain staff on these floors because of what med-surg has become. When I first entered nursing, doctors, nurses, hospital administration were in control and respected. Now, it appears that everyone other than us are controlling how we do our jobs. If we don't take the legally-addicted drug addict to the brink of death with those drugs (and back again), their pain wasn't controlled during their hospital stay, the satisfaction scores plummet, and so do the reimbursements. There goes the help! Again, my opinion based on reports from staff meetings/memos/emails, it's more of the disgruntled population that completes these surveys as it appears the happier ones get on with life and file these survey slips in the garbage with the other junk mail.
I could go on forever about what nursing has become on the floors, but I won't. We all know that if the floors were a great place to work, no one would mind being floated there. Nurses come, get that experience in more ways than one, and then move on.
How did I deal with being floated? I became a float nurse! No more mandatory meetings unless they were hospital-wide for all employees, including physicians; no more issues with getting time off as I set my own schedule, meaning that after I meet the minimum hours of my contract, I work as much or as little as I want and usually take a full week off every 3 weeks but NEVER sign up for full time hours unless a tropical road trip is on the horizon; no more getting caught up in the politics of what's happening on each unit; and the pay is outstanding!
When I couldn't deal with even that anymore, I accepted a full time job in the community and now float only one day per week on my only self-scheduled day of the week at the hospital for the same great pay.
I refuse to say that hospital (med-surg) nursing is only going to get worse; but what I will say is that it's not going to get any better. You just have to make it work for you. In doing so, you make it work for your patients.

Boy, did this post hit the nail on the head. It's so sad and so depressing, and one of the reasons many nurses (and now doctors) are starting to really make noise about CMS reimbursement and HCAHPS scores being tied together so tightly, for one thing. Alas, that topic is so deep and so full of fertilizer to dig through that it cannot be addressed here.

I have been in the exact same position. We appealed to our nurse manager to no avail, so instead we started writing incident reports for the many many MANY inappropriate and dangerous assignments. I would never ask a med surg nurse to come onto OB and read a fetal monitor tracing or check a cervix and do it correctly, so why on God's green earth were they expecting us to do things like read telemetry strips and push cardiac meds? Scary. So we started writing incident reports, for one, and refusing to sign off or accept telemetry patients, for another. Sorry, not appropriate. In the end, it resulted in our unit still being the house float pool, but our nurses only being used for "task" and taking assignments only if they felt comfortable. It also led to about half our department leaving.

Kooky Korky, BSN, RN · Jul 6, 2016

When I was floated to CCU from my regular area, the Sup made it clear to the nurses in CCU that I was not expected to watch the monitors or do drips or other distinctly CCU things.

I worked more as an aide. Did VS for all the patients, helped toilet, feed, did meds on a few (oral only), put strips in the charts, answered lights, helped with an admission, turned people, helped with HS care and a couple of baths, stocked med and treatment carts and emptied the trash from these, ran to Pharmacy a couple of times, helped answer the phones, straightened up kitchen, linens, and supply closet, controlled visiting, and this sort of thing. When docs rounded, I helped them with an invasive procedure.

I was able to take full care of two of their less critical patients, did some dressings, blood sugars and coverage, kept plenty busy, and was appreciated by all by the end of the shift, even if I didn't do monitors and drips.

Maybe you can work out something like this when you are floated to an area where you are not expert.

It doesn't like you feel a lack of ability or knowledge, OP, rather you don't like being pulled so much. As others have said, I hope your Manager will work to change this.

raptorfem, BSN, RN · Jul 6, 2016

I'm not sure what the consequences would be for outright refusing:no: to float, i'm guessing corrective action. Luckily where i work they would never try to float a med-surg nurse to peds or the ICU, thats completely absurd and dangerous IMO.

Since my unit (colorectal surgery, med-surg type floor with fairly high acuity post-op patients) is blessedly well-staffed, we are constantly floating out to other units. It is very frustrating when we continuously go to the same poorly/staffed, disorganized, hot mess units; its obvious to everyone that the hospital has no incentive to adequately staff those units when we can just float there! No need to go through the hiring process, train new RNs, or compensate more float pool nurses - just make us float constantly

holisticallyminded · Jul 6, 2016

As someone who floats for a living (on-call) and ALWAYS has (yes, even in my very first RN job and also before I was an RN and worked in another healthcare area), I just don't think it's a big deal. If you're a nurse, you're a nurse. If you aren't familiar with something, you ask someone else. If you're overwhelmed, you ask for help. The key is honesty and thoughtfulness. As long as you're working in a situation where there are others around (as opposed to home health, etc) there is usually someone to help. Now if there isn't, run for the hills! Otherwise, it'll all become old hat over time.

Wile E Coyote, ASN, RN · Jul 6, 2016

As someone who floats for a living (on-call) and ALWAYS has (yes, even in my very first RN job and also before I was an RN and worked in another healthcare area), I just don't think it's a big deal. If you're a nurse, you're a nurse. If you aren't familiar with something, you ask someone else. If you're overwhelmed, you ask for help. The key is honesty and thoughtfulness. As long as you're working in a situation where there are others around (as opposed to home health, etc) there is usually someone to help. Now if there isn't, run for the hills! Otherwise, it'll all become old hat over time.

Ah, the old "a nurse is a nurse" thinking. Any nurse should be able to function in Peds, OB, OR, Utilization Review, ICU, PICC team, Code Team, PACU, M/S, Oncology, Psych, House Supervisor, Nurse Manager, Neuro, NICU, LTC, Infection Control, Pre-Op clinic, Occ Health, Education, Burns, ED, Cath Lab, EP lab, Radiology, Resource Nurse, Office nurse, Case Management...(I went absurdly overboard for effect). All of those areas have others around to help, so it should go just fine, right?

Your float pool position is in itself a specialty, and does not reflect the concerns of core staff being floated.

msfb · Jul 6, 2016

I feel very fortunate that my hospital system does not float adult med surg nurses to pediatrics or mother baby and vice versa. If you refuse to float we get an absence and written up. We have multiple float pools from specialties to general that does all adult needs inclung er and pacu. There are still times that an ortho nurse can get floated to a med surg floor when census the ortho census is low. The float pool is huge but not big enough for all needs when the hospital is hopping.

SallyRNCNOR · Jul 6, 2016

You can refuse to float to a floor if you don't have experience on that floor, by saying I don't feel safe in floating. If you say this to a Nursing Manager, make sure that you document somewhere or had a witness to that conversation. This puts the responsibility on the Nursing Manager, knowing that she forced you to work in an unsafe environment. If she/he insists then you can tell her/him that you would be willing to do vital signs, and perhaps pass meds, but don't want to take patients, as you feel unsafe and haven't been trained in that area.. Also get together with your Nurse manager and all the staff on your unit. keep a spreadsheet documenting how many times the staff has been floated. This is also a way to keep track of the staff that is floated so one particular nurse doesn't get floated out of turn. When you have enough data, you can present that to Administration to prove that there is short staffing and give a possible solution as to what can be done about it;e.g. limiting the amount of staff that could be given time off at one time.

There seems to be a problem with the Nurse Manager giving all staff off when they ask for it without providing for staffing her unit without floats. They should keep a log book for requests for time off without having more than 2 people per shift off at the same time.

Guttercat, ASN, RN · Jul 6, 2016

I no longer work "the floors," but I would hope the float policies are better than what they were in my first position many years ago.

Brand new grad working on a new grad license until I passed NCLEX, 18 bed ICU which was mostly a MICU/CVICU patient population. Was sent on my own after two and a half weeks of precepting and some "classes." About 8 weeks in, they floated me to the Neuro ICU...alone in an unsupported unit (no CNA's, nada) with four neuro ICU patients. I was the only RN overseeing their care.

Unreal. Poor patients. Thankfully I didn't kill anyone.